Objective:To explore the clinical value of carotid artery stent implantation(CAS)and carotid endarterectomy(CEA)in the treatment of patients with severe internal carotid artery stenosis.Methods:88 patients with severe...Objective:To explore the clinical value of carotid artery stent implantation(CAS)and carotid endarterectomy(CEA)in the treatment of patients with severe internal carotid artery stenosis.Methods:88 patients with severe carotid artery stenosis who underwent CAS and CEA in the First People's Hospital of Changde City(hereafter referred as "our hospital")from January 2018 to December 2020 were selected as the research objects and divided into CAS group(n=43)and CEA group(n=45).To understand the clinical application value and feasibility of the two surgical schemes by comparing the general situation,cerebral blood flow,MMSE scale,MOCA scale score and serum miR-145,IGF1R levels of the two surgical schemes.Conclusions:CAS and CEA in the treatment of patients with severe internal carotid artery stenosis,have good curative effect,can effectively improve the patient's cerebral blood flow,regulate serum miR-145,IGF 1R levels,promote the recovery of cognitive function,but relatively speaking,the incidence of stroke and hypotension after CAS is higher,and the incidence of hypertension after CEA is higher.展开更多
Background Angina pectoris has been recognized as one of the principal symptoms of aortic valve stenosis （AS）,even in patients without significant coronary artery disease （CAD）.However,the incidence of angina pect...Background Angina pectoris has been recognized as one of the principal symptoms of aortic valve stenosis （AS）,even in patients without significant coronary artery disease （CAD）.However,the incidence of angina pectoris and related CAD in such patients is controversial.There is continuing debate as to whether coronary angiography is necessary before aortic valve replacement （AVR） in patients with severe AS.The purpose of this study was to evaluate the incidence and predictors of CAD in patients with severe AS in a Korean population.Methods Data from all consecutive patients with severe AS undergoing AVR at a major tertiary cardiac and vascular center in Korea were entered in a prospective registry beginning in 1995.Clinical and echocardiographic follow-up data were recorded into the database annually.Significant CAD was defined as one or more major coronary arteries having an estimated narrowing of ≥70％ and left main coronary arteries having an estimated narrowing of ≥50％ on coronary angiography.We excluded patients with multiple valve disease,significant aortic regurgitation,or prior CAD or valve surgery.Results Totally 574 patients with severe AS （mean age,（65.9±9.6） years） were enrolled in this study.Significant CAD was found in 61 patients （10.6％）.Factors associated with increased likelihood of CAD were age,hypertension,diabetes mellitus,chronic renal failure,carotid disease,and aorta calcification.In Logistic regression analysis,the independent predictor of the presence of CAD was age （P=0.011）.The incidence of CAD increased significantly at 69.2 years of age.Having two risk factors for cardiovascular disease was the most useful cutoff to predict whether a patient was going to have significant CAD.Conclusions There was a low incidence of significant CAD in a population of Korean patients with severe AS.Therefore,coronary angiography before AVR will be considered in patients with multiple risk factors for cardiovascular disease or in patients more than 69 years of age without risk factors for cardiovascular disease.展开更多
With the development of science and technology and the continuous progress of interventional equipment,internal carotid artery stenting has become increasingly popular among patients in view of its advantages,which in...With the development of science and technology and the continuous progress of interventional equipment,internal carotid artery stenting has become increasingly popular among patients in view of its advantages,which include high efficiency,minimally invasive,and fast postoperative recovery.It has grown importance as a surgical method for the treatment of severe internal carotid artery stenosis.This paper discusses a rare case of severe internal carotid artery stenosis and its management,where various types of pre-dilatation balloons were not able to be positioned in the stenting process.Relevant solutions have also been proposed in hope to provide a more theoretical and practical basis for clinical work.展开更多
Background: Aortic stenosis (AS) is caused by either age-related degeneration of aortic valve or congenital malformation of aortic cusps. Severe aortic valve stenosis is a clinically emerging diagnosis in the current ...Background: Aortic stenosis (AS) is caused by either age-related degeneration of aortic valve or congenital malformation of aortic cusps. Severe aortic valve stenosis is a clinically emerging diagnosis in the current world. The three cardinal signs of severe AS are dyspnea, syncope, and angina. Transcatheter aortic valve implantation is one of the safe and effective methods for treating severe aortic valve stenosis, and an alternative to surgery in high-risk patients. Aortic valve calcification and changes after TAVI were specifically assessed by computed tomography. Excessive aortic valve calcification is related to procedural complications. A possible consequence is obstruction of coronary ostia. Heavy calcification of the aortic valve and surrounding structure is an important risk factor for coronary obstruction, heart block, and embolization during aortic valve implantation (TAVI). Here we present a case of an elderly old man, where critical ostial left main coronary artery (LMCA) disease was caused by shifting of a calcium speck rather than obstruction with native leaflet. He was successfully rescued by an emergent CABG. Methods and Results: This is a case of a 69-year-old man with severe calcific aortic stenosis and single-vessel CAD who underwent TAVI with a relatively unremarkable course. Notably, his pre-operative TAVI angiography showed no LMCA stenosis. But 10 days later he presented to the ER with acute myocardial infarction with peak high-intensity troponins, diffuse ST changes, and cardiogenic shock. Urgent coronary angiography and intravascular ultrasound showed critical LMCA stenosis caused by a speck of calcium externally abating the vessel. He underwent emergency coronary artery bypass grafting;intraoperative TEE confirmed the etiology. He had an uneventful postoperative course and was successfully weaned off vasoactive medications. Conclusion: This case illustrates that obstruction of coronary ostia could be a possible complication of TAVI. Calcium distribution should factor in TAVI versus surgical candidacy. Calcium shifting should be watched closely during valve deployment, post-TAVI coronary angiogram should be considered if shifting was significant or suspected to compromise coronary arteries.展开更多
文摘Objective:To explore the clinical value of carotid artery stent implantation(CAS)and carotid endarterectomy(CEA)in the treatment of patients with severe internal carotid artery stenosis.Methods:88 patients with severe carotid artery stenosis who underwent CAS and CEA in the First People's Hospital of Changde City(hereafter referred as "our hospital")from January 2018 to December 2020 were selected as the research objects and divided into CAS group(n=43)and CEA group(n=45).To understand the clinical application value and feasibility of the two surgical schemes by comparing the general situation,cerebral blood flow,MMSE scale,MOCA scale score and serum miR-145,IGF1R levels of the two surgical schemes.Conclusions:CAS and CEA in the treatment of patients with severe internal carotid artery stenosis,have good curative effect,can effectively improve the patient's cerebral blood flow,regulate serum miR-145,IGF 1R levels,promote the recovery of cognitive function,but relatively speaking,the incidence of stroke and hypotension after CAS is higher,and the incidence of hypertension after CEA is higher.
文摘Background Angina pectoris has been recognized as one of the principal symptoms of aortic valve stenosis （AS）,even in patients without significant coronary artery disease （CAD）.However,the incidence of angina pectoris and related CAD in such patients is controversial.There is continuing debate as to whether coronary angiography is necessary before aortic valve replacement （AVR） in patients with severe AS.The purpose of this study was to evaluate the incidence and predictors of CAD in patients with severe AS in a Korean population.Methods Data from all consecutive patients with severe AS undergoing AVR at a major tertiary cardiac and vascular center in Korea were entered in a prospective registry beginning in 1995.Clinical and echocardiographic follow-up data were recorded into the database annually.Significant CAD was defined as one or more major coronary arteries having an estimated narrowing of ≥70％ and left main coronary arteries having an estimated narrowing of ≥50％ on coronary angiography.We excluded patients with multiple valve disease,significant aortic regurgitation,or prior CAD or valve surgery.Results Totally 574 patients with severe AS （mean age,（65.9±9.6） years） were enrolled in this study.Significant CAD was found in 61 patients （10.6％）.Factors associated with increased likelihood of CAD were age,hypertension,diabetes mellitus,chronic renal failure,carotid disease,and aorta calcification.In Logistic regression analysis,the independent predictor of the presence of CAD was age （P=0.011）.The incidence of CAD increased significantly at 69.2 years of age.Having two risk factors for cardiovascular disease was the most useful cutoff to predict whether a patient was going to have significant CAD.Conclusions There was a low incidence of significant CAD in a population of Korean patients with severe AS.Therefore,coronary angiography before AVR will be considered in patients with multiple risk factors for cardiovascular disease or in patients more than 69 years of age without risk factors for cardiovascular disease.
文摘With the development of science and technology and the continuous progress of interventional equipment,internal carotid artery stenting has become increasingly popular among patients in view of its advantages,which include high efficiency,minimally invasive,and fast postoperative recovery.It has grown importance as a surgical method for the treatment of severe internal carotid artery stenosis.This paper discusses a rare case of severe internal carotid artery stenosis and its management,where various types of pre-dilatation balloons were not able to be positioned in the stenting process.Relevant solutions have also been proposed in hope to provide a more theoretical and practical basis for clinical work.
文摘Background: Aortic stenosis (AS) is caused by either age-related degeneration of aortic valve or congenital malformation of aortic cusps. Severe aortic valve stenosis is a clinically emerging diagnosis in the current world. The three cardinal signs of severe AS are dyspnea, syncope, and angina. Transcatheter aortic valve implantation is one of the safe and effective methods for treating severe aortic valve stenosis, and an alternative to surgery in high-risk patients. Aortic valve calcification and changes after TAVI were specifically assessed by computed tomography. Excessive aortic valve calcification is related to procedural complications. A possible consequence is obstruction of coronary ostia. Heavy calcification of the aortic valve and surrounding structure is an important risk factor for coronary obstruction, heart block, and embolization during aortic valve implantation (TAVI). Here we present a case of an elderly old man, where critical ostial left main coronary artery (LMCA) disease was caused by shifting of a calcium speck rather than obstruction with native leaflet. He was successfully rescued by an emergent CABG. Methods and Results: This is a case of a 69-year-old man with severe calcific aortic stenosis and single-vessel CAD who underwent TAVI with a relatively unremarkable course. Notably, his pre-operative TAVI angiography showed no LMCA stenosis. But 10 days later he presented to the ER with acute myocardial infarction with peak high-intensity troponins, diffuse ST changes, and cardiogenic shock. Urgent coronary angiography and intravascular ultrasound showed critical LMCA stenosis caused by a speck of calcium externally abating the vessel. He underwent emergency coronary artery bypass grafting;intraoperative TEE confirmed the etiology. He had an uneventful postoperative course and was successfully weaned off vasoactive medications. Conclusion: This case illustrates that obstruction of coronary ostia could be a possible complication of TAVI. Calcium distribution should factor in TAVI versus surgical candidacy. Calcium shifting should be watched closely during valve deployment, post-TAVI coronary angiogram should be considered if shifting was significant or suspected to compromise coronary arteries.
